Introduction. Foreign bodies in the gastrointestinal tract are various objects of organic and inorganic origin, which are swallowed - not as food - either accidentally or intentionally. The article describes a clinical case of a 13-year-old child with multiple foreign bodies in his gastrointestinal tract which could cause serious complications, such as: perforation of hollow organs, peritonitis, intestinal obstruction, internal bleeding. By statistics, every fourth patient of the conscious age with foreign bodies in the gastrointestinal tract can potentially have problems in the neuropsychic sphere.Material and methods. A 13-year-old boy was admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) with nausea, repeated vomiting after each meal and water drinking. The careful anamnesis revealed that before the boy’s state deteriorated, he had swallowed a large number of magnets and metal objects within a short period of time. X-rays examination found multiple foreign bodies in his gastrointestinal tract. They were removed during esophagogastroduodenoscopy (EGDS) and surgical intervention.Results. The plain-film X-ray examination of the abdomen in the projection of the stomach revealed a radiopaque group of foreign bodies of a rounded shape as a conglomerate. At FEGDS, 54 objects were removed: 4 metal balls up to 0.5 cm in diameter, 47 round magnets up to 1.5 cm in diameter, a metal chain and two screws. During laparotomy and gastrotomy 99 foreign bodies were removed: 82 magnet balls 0.5 cm in size, 16 metal balls 1.5 cm in size, 1 bolt. The postoperative period was uneventful. The child was discharged on the 12 th day after surgery in the satisfactory state.Conclusion. Due to timely diagnostics and proper curative tactics, multiple foreign bodies were revealed and removed from the child’s stomach endoscopically and surgically within a short period of time. A correctly chosen curative tactics resulted in a complete recovery of the patient without complications on the 12th hospitalization day.

Introduction. Severe injury is referred to as types of child injury with a high mortality rate. One of the causes of fatal outcomes is bleeding from acute ulcers of the gastrointestinal tract. Bleeding from acute ulcers of the upper gastrointestinal tract is considered to be both not only the cause of deaths and also a factor in secondary hypoxic damage to organs and systems, leading to a complicated course of the post-traumatic period. Aim of the study. To substantiate the protocol of endoscopic monitoring of the state of the upper GI tract in the critical period of severe trauma in children. Material and Methods. 124 children aged from 0 to 18 years were examined. The severity of injury according to an ISS scale was 27.5 ± 10.1 scores. All patients were divided into 6 groups on the basis of leading damage. Esophagogastroduodenoscopy with the examination of the initial segments of the jejunum was performed on the 7-10th day of the post-traumatic period. In children with a severe spinal injury, esophagogastroduodenoscopy was performed on the 1-2nd day. The presence of pathological impurities, the condition of the mucous membrane, and peristaltic activity was evaluated. In the diagnosis of bleeding, combined endoscopic hemostasis was performed. Results. Erosions and ulcers were identified as the main endoscopic pathology in groups of children with leading skeletal and abdominal trauma, as well as with combined trauma with competing injuries. The group with abdominal trauma was leading in the number of gastrointestinal bleeding. Conclusion. Destructive changes in the upper GI tract are typical for the critical period of severe injury. It determines the mandatory planned conduct of esophagogastroduodenoscopy in the monitoring mode.

Objective of the Paper: To present a case of successful use of Peroral Endoscopic Myotomy (POEM) in oesophageal achalasia in a 6-year-old child at the Scientific and Research Institute of Emergency Paediatric Surgery and Traumatology. Key Points. Being highly efficient and minimally invasive, POEM has been gaining in popularity in management of oesophageal achalasia in adult patients. However, in paediatrics, clinicians remain wary of the method. POEM was used to treat grade 3 oesophageal achalasia in a 6-year-old girl. No intraoperative complications were recorded. The postoperative period was uncomplicated: feeding with strained food started the next day after surgery; the child was discharged from the hospital on day 3. During follow-up visits (3, 12, 24 months) the child did not have any complaints; symptoms of dysphagia regressed completely; 3-month weight gain was 4kg; endoscopic examination showed an unobstructed oesophagus without inflammation. Conclusion. POEM is a promising method for management of oesophageal achalasia in children; still, controlled randomised studies should be conducted in order to assess the efficiency of the method in comparison with the efficiency of laparoscopy and balloon dilatation. Keywords: endoscopy, children, oesophageal achalasia, peroral endoscopic myotomy.

Introduction. Lymphangiomas are mature benign tumors emanating from the lymphatic vessels making up 9-10% of all benign neoplasms in pediatric oncology. In our practice, we have encountered a rare complication of the lymphangioma of the abdominal cavity - an ileus Objective: To present a clinical picture, diagnostic and surgical tactics in a rare clinical observation of mesenteric lymphangioma, complicated by ileus. Material and methods. Boy aged of 6 years 4 months. He was taken to the emergency department of the Research Institute of NDHiT by an ambulance team (SMP) with suspected acute appendicitis 6 hours after the onset of the disease. Results. According to the results of clinical, laboratory and echographic examination, a child with a clinical picture of “acute abdomen” was suspected of an abdominal lymphangioma. For the purpose of the differential diagnosis of a complicated course of the lymphangioma of the abdominal cavity with complicated destructive appendicitis, 2 hours after hospitalization, laparoscopy was performed and there was confirmed lymphangioma of the ileum mesentery, complicated by the twisting of the latter. After elimination of the torsion, a section of the ileum with a tumor was resected with an end-to-end anastomosis. Histologically, the diagnosis of lymphangioma was confirmed. Conclusion. The cause of “acute abdomen” may be the development of complications of the mesenteric lymphangioma. Timely hospitalization of the child in a specialized hospital allows making a diagnosis in a timely manner, select the optimal surgical tactics and prevent life-giving complications